title: Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature.
abstract: Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.
authors.affiliation: Tarkan Jäger, Clemens Nawara, Adam Dinnewitzer, Dietmar Öfner, Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria.
authors.forename: Tarkan
authors.initials: T
authors.lastname: Jäger
authors.forename: Daniel
authors.initials: D
authors.lastname: Neureiter
authors.forename: Clemens
authors.initials: C
authors.lastname: Nawara
authors.forename: Adam
authors.initials: A
authors.lastname: Dinnewitzer
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ofner
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
keywords: Diaphragmatic hernia; Hiatal hernia; Intrathoracic duodenum; Intrathoracic pancreas; Paraesophageal hernia